Combination of photodynamic therapy with 5‐aminolaevulinic acid and microneedling in the treatment of alopecia areata resistant to conventional therapies: our experience with 41 patients

Abstract

Summary Alopecia areata (AA) is a complex immune‐mediated disorder, which is difficult to treat. The available treatment options seem to have limited benefit, help only some patients and have a high relapse rate. We evaluated a new therapeutic option for moderate to severe AA based on the combination of photodynamic therapy (PDT) with 5‐aminolaevulinic acid (ALA) and microneedling (MN). In total, 14 patients were enrolled, and these were randomly divided into 3 groups: Group A (MN alone; n = 9), Group B (ALA‐PDT alone; n = 15) and Group C (combination of MN and ALA‐PDT; n = 17). All patients were treated once every 3 weeks for a total of six treatments. The best clinical outcome was achieved in Group C, with complete hair regrowth observed in three patients, and an improvement of ≥ 50% and < 50% of the treated areas obtained in seven and six patients, respectively. Our report suggests that combination of ALA‐PDT with MN could be an additional therapeutic option in moderate to severe AA, as MN allows better skin penetration of ALA and subsequent indirect immunosuppression.

A Literature Review of the Microneedle Therapy System for Hair Loss

“…A study on alopecia totalis [7] showed that none of the treatments had a beneficial effect. In the study of moderate to severe AA [10], only the MTS was not effective however, the MTS + PDT group showed significant improvement compared with the PDT alone group.…”

“…About 33% of the AGA patients were given topical MXD or oral finasteride (conventional treatment), and the rest of the treatments were not reported. It was reported that all AA patients had been treated for many years with the conventional treatment (but the treatment was not mentioned) which were not effective [7,10]. The MTS treatment intervals were as follows: 0-1 week (1), 1-2 weeks (4), 3 weeks (2), and 4 weeks (2).…”

“…In the AGA and TE studies, 1.5 mm needles in the rollers were used except for in 2 RCTs [11,12]. However, in the AA study, 5 mm needle roller and a 1 mm needle pen were used [7,10,13]. There were 4 RCTs [14-17] that compared the MTS with 5% MXD treatment, and there was 1 clinical study where plateletrich plasma was used [12].…”

“…There were 4 RCTs [14-17] that compared the MTS with 5% MXD treatment, and there was 1 clinical study where plateletrich plasma was used [12]. Two studies compared the MTS to conventional (not reported) treatments [11,13], and another 2 AA studies [7,10] compared PDT with the MTS.…”

Successful response to photodynamic therapy with 5‐aminolevulinic acid nanoemulsified gel in a patient with universal alopecia areata refractory to conventional treatment

“…4 Over the last 20 years, PDT has been proposed as an alternative in the management of extensive forms of AA, either in isolation or combined with microneedling systems. [5][6][7][8][9] Management of universal AA regarding the use of 5-ALA has traditionally been unsatisfactory, considering it ineffective. Unfortunately, previously case series and cases reported do not completely support the successful results obtained in our case (Table 1).…”